Article Date: 3/1/2013

A Look Inside Four XFRACTION SM Practices

A Look Inside Four XFRACTIONSM Practices

Four optometrists from across the country share their perspectives on this marriage of autorefraction and aberrometry.

Wavefront technology has enabled eyecare practitioners to go beyond traditional refraction and measure patient’s higher-order aberrations. The combination of wavefront aberrometry and refraction can deliver a picture of the complete visual system. In its exploration of this relationship, Marco has developed software to integrate the data from its OPD-Scan III aberrometer and the TRS-5100 autorefractor. The system, called XFRACTION, enables doctors to achieve what’s called “wavefront-optimized refraction.”

The XFRACTION software lays out more than 20 diagnostic measures harvested by the devices. In less than 1 minute, users know which patients need full refraction for 20/20 vision and which patients need only basic refinement. Overall, the system saves about 5 to 7 minutes per wavefront patient, compared to manual refraction. Most importantly, patient outcomes include better prescriptions and treatment for visual complaints that often didn’t have solutions in the past.

Here, four accomplished optometrists from around the country, all XFRACTION process users, share their perspectives on the system, including how they use the technology in their practices, the clinical results they’ve seen, how the process directly affects revenue and what patients think of XFRACTION.

Michael Johnson, OD, Eagle Vision Eye Care Optometric Group, Sacramento, Calif.: “My staff typically performs the pretesting. This includes screening fields, OPD and lensometry. The OPD and lensometry readings are loaded into the TRS, and from there, I can refine the final prescriptions within minutes — sometimes less. Additionally, the TRS makes binocular vision and near-point testing a breeze.” images

Ryan Rosemore, OD, Rosemore Eye Care, Plano, Texas: “I run the scan myself, so I get a good feel for the validity of the measurements. I want to see if patients are looking straight ahead and following instructions, as well as if they’re blinking, squinting or showing light sensitivity. It’s a very fast and simple scan that gives me a great deal of information.”

“With two doctors, we keep two lanes going with two automated refractors. We have a manual phoropter for slow prism movement with kids or vision therapy patients, but nearly all of our patients undergo refraction on the automated refraction system.”


How Have You Incorporated XFRACTION into Your Practice?

New technologies usually sound good, but you don’t know how they’ll work in your practice until you take delivery. The goal is always ease of use and a short learning curve. The rest is up to you. Do you use the device yourself or delegate the work to technicians? Do you use it on all patients or a select few? After a few months, the new device will be integrated into your exam lane, your work patterns and electronic health records (EHRs). And you’ll have a good idea of all of its functions and which ones provide the most assistance.

Chris Deibert, OD, Valley Eye Clinic, Luray, Va.: “I use the XFRACTION system on all of my patients. The OPD-Scan is very fast and easy for technicians to operate, so they do the scan and download it into the TRS-5100 for me.

“This device has really changed the way I perform refractions. It would be hard to go back to using a regular phoropter now. While patients are behind the eyepiece, I’m changing the lenses from a control panel a few feet away. It’s more accurate than any other autorefractor I’ve used.

“It generates a great deal of information and displays it in different tiles I can arrange for fast, easy analysis. I can customize the corneal topography, internal OPD, point spread function, total and higher-order wavefront, pupillometry and refractive maps in a way that works best for my practice. Based on whether the system displays autorefraction alone or with wavefront refraction, I rapidly know if the patient needs a straightforward new prescription or additional correction.”


Steven Chander, OD, Primary Eye Care Associates, Chicago: “MARCO helped me implement a new workflow that quickly provided a good ROI for the technology. We discussed the “one-point,” or “one-touch” examination. We see patients from start to finish, including dilation, either sending them to the optical area after the exam or letting them choose frames as a first step. It’s a brilliant process. Our workflow is very smooth and efficient.” images

How Does XFRACTION Improve Your Diagnostic Capabilities?

There’s no room in your practice for a new device that doesn’t offer a significant improvement in some key area, whether it’s efficiency, record-keeping or clinical quality. For example, getting more data doesn’t necessarily represent an improvement unless you can actually do something with the data in a practical and timely way. XFRACTION delivers data in a way that provides wavefront optimized refraction. Could that help your patients? And does it offer any other advantages?



Chris Deibert, OD: “XFRACTION has helped to make patient assessments more accurate and efficient overall, and the system is especially useful for cataract and LASIK co-managing practices. To help select an IOL, I use many of the digital measurements, such as higher-order aberrations, front surface topography and corneal asphericity. I can tell how much of a patient’s astigmatism is in the cornea versus the lens and determine which IOL will best neutralize a patient’s astigmatism for night driving. And unlike other wavefront refractions tied to specific lenses, the OPD-Scan III isn’t tied to any optical product.

“The system does an exceptional job of evaluating day and night vision as well. The TRS-5100 performs one refraction in daylight conditions and another refraction with the pupil dilated for nighttime conditions. In about night 5% to 10% of my patients, I find that the day and night prescriptions are significantly different. That doesn’t always require a change in correction — some patients are better off sticking with a single pair of eyeglasses. But about 5% of patients can benefit from having separate pairs of eyeglasses for day and night. I’m not following a general rule of thumb to add minus for nighttime — I’m getting each patients’ exact nighttime prescription and addressing their frustrations.

“For day and night correction, old and new prescriptions, or even just to compare ‘1 or 2,’ the TRS-5100’s split prism is an interesting feature. Patients can see both lenses side by side, rather than one after the other. Because the patient has to be centered in the aperture for this to work, I only use it occasionally, but it’s the first time I’ve been able to offer patients a head-to-head comparison to give them a clear choice or help them understand my recommendation.”


Steven Chander, OD: “Day-versus-night vision, including night vision problems, are made very clear. In a very short time, I get highly accurate refraction and topography to guide vision correction. It’s a very fast process, but also extremely accurate.” images

Ryan Rosemore, OD: “The refraction itself is extraordinarily accurate. I rarely need to make any additional refinements to the automated measurements with wavefront patients.

“I’ve gotten excellent topographic results as well. The topography and retro illumination help me evaluate patients with cataracts. It’s also easy to see pellucid marginal degeneration or keratoconus. And when a patient comes to me after getting a bad fit for RGP lenses, I send the topography straight to the lab. I’ve had good results fitting those patients.”


Michael Johnson, OD: “Who wouldn’t want to provide their patients a better, faster, more accurate refractive exam?

“XFRACTION differentiates me from the competition because it helps me better understand the patient’s refractive system. This is advantageous for all patients, especially those with vision problems that would have proved difficult to diagnose in the past.

“It’s frustrating not only for the patient, but also for me as a doctor when a seemingly healthy individual with no ocular pathology is unable to see 20/20 or can see 20/20, but still isn’t satisfied with the “quality” of his vision. With a traditional autorefractor, you typically get K-readings and an average refractive reading. With the OPD, you virtually follow the light through the optical path of the eye. Patients are very impressed and sometimes relieved when you can show them why their refractive system is producing a sub-par image.

“Often, these patients have worse vision at night. They benefit from a night vision assessment, and this often translates into needed second pair sales.”


Does XFRACTION Increase Your Revenues?

There are only two ways to increase revenues: See more patients or earn more for each patient visit. Clearly, seeing more patients means spending less time per patient. Earning more per visit can mean increasing optical revenues, reducing remakes or a host of other strategies. XFRACTION is designed for speed and accuracy. How does that translate into revenue in optometric practices?





Chris Deibert, OD: “I’ve seen some revenue increase in the optical area from day and night prescriptions, but the real financial benefit is that XFRACTION makes things more accurate and efficient overall. It cuts down on chair time. I can complete a refraction in a couple of minutes, and I can perform some binocular vision tests more quickly than I could with the manual phoropter as well.

“What that means to your practice depends on your volume. We’re fairly busy in my practice, completing 15 to 18 full exams per day, as well as another 15 to 20 medical visits for glaucoma, cataract post-ops, and acute problems. With more than 30 total patient encounters per day in three exam rooms, you need ways to be as efficient as possible while maintaining (or increasing) the level of accuracy and patient care. I may eventually delegate autorefraction to my technicians to boost our efficiency even more.”


Steven Chander, OD: “I saw how the OPD-Scan III and TRS 5100 refraction system would pay for themselves by facilitating the sales of multiple eyewear, as well as boosting efficiency to see at least 2.5 more patients a day. Since then, we further enhanced our workflow by adopting the EPIC system — now adding four more patients a day.” images

Michael Johnson, OD: “The OPD takes less than a minute to complete a reading, and the TRS is quiet and fast. The combination helps to decrease testing time by 5 to 10 minutes. Since we incorporated the OPD with the TRS, we’ve been able to see at least four more patients a day, sometimes more. This translates into more optical and exam revenue without increasing fixed overhead.

“Obviously, seeing four more patients per day increases revenues significantly. A smaller increase in optical revenues is made possible by the ability of XFRACTION to provide day and night prescriptions. A portion of those patients with significantly different prescriptions choose to get two pairs of eyeglasses.

“The system also fulfills one of my major goals for purchasing it in the first place: EHR compatibility. I’ve been using the OPD and the TRS since I moved my practice 4 years ago. Up until that time, I’d been using a traditional auto-refractor, phoropter and paper records for my refractive needs. My previous method was adequate, but looked and felt outdated. Also, with the looming threat of mandatory EHR, I decided it was time to make a change. All of the XFRACTION system data imports seamlessly into my EHR, which has eliminated transcription errors and resulted in fewer remakes due to careless errors.

“Finally, I consider XFRACTION to be good for my bottom line because its excellent ergonomics keep me working comfortably. After years of using my traditional phoropter, I developed tendonitis in the elbow and forearm. I sought treatment from a hand specialist and went through physical therapy, massage, acupuncture and cortisone shots. The pain continued for several years. Once I started using the TRS, the pain went away.”


Ryan Rosemore, OD: “Speed is the advantage. Being able to trust the cylinder measurement cuts my time in half. In using XFRACTION for 4 months, I’ve had one prescription rejection on the basis of cylinder, compared to about one per month when I was refracting manually.

“The system also links seamlessly with all of our devices and our practice management software, which saves time and results in fewer errors during information transfer.”


What Do Your Patients Think of XFRACTION?

Any practice consultant will tell you to look at your practice from the patient’s perspective. It’s hard to know what kind of response your gray carpet may elicit, but technology is another matter.



Ryan Rosemore, OD: “When I looked into XFRACTION, I talked to people at larger practices. They told me that a big selling point is that even if you’re not so busy that you need to push patients through faster, patients like to see a digital system because that’s how everything works now. It looks more ‘normal’ to see an automated electronic device than to see something that hasn’t changed in decades. So even if my schedule wasn’t full yet, I knew it would still make a difference in the patient experience. Additionally, my patients have never seen anything like it, which shows me that other offices aren’t doing this yet.

“The potential for education is great, too. I can show patients their cataracts or the aberrations causing their night vision problems. That’s helped them understand what’s going on with their eyes. Looking at the Snellen charts with and without glasses makes sense to them as well. They’re not used to seeing the problem and feeling like a part of the exam, but now it’s very easy to explain problems to them and have more of a partnership experience.”


Steven Chander, OD: “From my patients’ perspective, I wanted an automated refraction technology to deliver three things: 1) a marriage of accuracy with a patient ‘wow’ factor,” 2) something easy for patients to understand, and 3) the ability to demonstrate how an individual will benefit from multiple eyewear or high-end lens and coating technologies. The OPD-Scan III and TRS 5100 deliver all three.” images

Michael Johnson, OD: “Patients are constantly commenting on my office being technologically advanced. XFRACTION increases efficiency, accuracy and speed, resulting in better patient flow and a better patient experience. Patients actually have fun with the process because it’s so much quicker. And because the testing time is decreased, I can spend more time with them discussing their exam findings and optical needs.” images

Chris Deibert, OD: “Patients are impressed when they see the autorefractor. They’ve never seen that before. They’re very used to the ‘Which is better, 1 or 2?’ question and they dislike it.” images

Much in Common
The words of four doctors from different practices show that many common threads of experience bind together XFRACTION’s partnering of aberrometry and autorefraction. With time to use and integrate the technology, all four doctors are using it for enhanced, wavefront-optimized refraction. Slipping easily into their work patterns and data flows, XFRACTION has also helped the doctors identify night vision problems and co-manage surgery.

XFRACTION’s accuracy and comprehensive data collection are delivered at a very high speed, saving time in all four practices. Benefits include gaining time to see more patients, reducing remakes and increasing optical revenues through day and night correction. What’s more, their patients have been impressed with the autorefractor and have gained from use of XFRACTION as a teaching tool. All in all, the marriage of autorefraction and aberrometry appears to be a very important step forward for optometry. ■

Optometric Management, Volume: , Issue: March 2013, page(s):